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Medical schools 'should have funding linked to producing GPs'

Medical schools ‘have a responsibility’ for addressing the GP workforce crisis and should have their funding linked to their achievement of targets on number of GPs produced, a study led by a senior Government advisor has concluded. 

The study - ‘A systematic review of strategies to recruit and retain primary care doctors’, published in BMC Health Services Research - also found that advertising campaigns to attract junior doctors to general practice have been detrimental in some countries.

In its review of 51 studies, the paper highlights that few government interventions to increase GP recruitment – many of which are being implemented as part of the NHS’s ten-point plan for GP workforce – are supported by robust evidence.

GP leaders have said the paper shows that one-off interventions are not going to solve general practice’s ongoing workforce crisis, and that the best advert for the profession is investment so trainees see it as an attractive place to work.

The study was authored by Sir Sam Everington, chair of NHS Tower Hamlets CCG and an adviser to NHS England, and Professor Amanda Howe, vice-chair of the RCGP, among others.

It published figures revealing that fewer than 10% of graduates from Oxford and Cambridge universities went on to a career in general practice.

Health education leaders are currently conducting a review into medical school culture, and the report authors urged the Government to link funding to universities’ output.

The study concluded: ‘Medical schools have a responsibility to start taking notice of the workforce crisis in primary care and perhaps resources and funding for these universities should be based on output to meet targets.

‘Universities should be held accountable as to how much time they allocate to the primary care setting and this data should be made publically available.’

The review also found:

  • that an advertising campaign to recruit GPs in the USA had a negative effect on potential candidates, with half of those who watched the video opting for a career in general practice compared with those who didn’t watch it.
  • there could be benefits from offering additional postgraduate training in under doctored areas;
  • ‘mixed results for the use of financial incentives’, such as golden handshakes, which it said was most effective in trainees ‘who had existing links to the underserved area’;
  • that there was widespread failure to effectively evaluate the outcome of interventions with few studies employing effective comparison groups, and no randomly controlled trials on the subject.

Many of these incentives formed part of Health Education England and NHS England’s ten-point plan.

HEE are currently offering £20,000 to more than 100 junior doctors willing to train as GPs in areas like Cumbria, while it last year ran a disastrous promotional video that highlighted extra-contractual work signing sky-dive forms as a reason to be a GP.

The chair of the GPC’s education, training and workforce subcommittee, Dr Krishna Kasaraneni, told Pulse: ‘The best marketing campaign, or strategy to improve GP recruitment is investing in general practice so the job is actually enjoyable for GPs to do. It isn’t for the majority, if not all of us.’

‘When that happens, when medical students come and spend time in general practice they will see a profession they want to join. It doesn’t matter what else you tell them, unless they see it and experience it themselves it’s not going to change.’ 

A HEE spokesperson told Pulse: ’No one intervention is going to make the difference. HEE and partners in NHS England, RCGP and BMA GPC are working together on many fronts including the 10 point plan initiatives to make recruitment flexible whilst maintaining standards and other measures to enhance the GP workforce.’

Tackling toxic medical schools

Maureen Baker-RCGP 2014-Online-cropped-(c) Rachael Meyer

Maureen Baker-RCGP 2014-Online-cropped-(c) Rachael Meyer

Pulse has already shown that medical schools are beginning to recognise the problems with primary care teaching.

Earlier this year Pulse revealed that the Medical Schools Council and Health Education England (HEE) would launch a review on the ‘profile of the GP culture’ in medical schools.

This comes after RCGP chair Maureen Baker attacked the ‘toxic’ anti-GP attitudes in some UK universities at the RCGP annual conference, and top GPs reported senior staff warning students not to ‘fail and become GPs’.

 

Readers' comments (25)

  • Until General Practice is something that is enjoyable and felt to be worthwhile, no-one will want to do it. If as a student all you hear from General Practitioners is how awful it is, why would anyone wish to become one. I love being a GP but even I am increasingly snowed under by demand and over regulation.

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  • Dear Peter I beg to disagree:
    I think the report is targeted at entirely the wrong people
    The universities have no interest, knowledge, or concern with regard to general practice, and would not see this as anything to do with them
    The postgraduate general practice vocational training deanery advertises, selects, appoints, pays, and trains the registrars
    These autonomous bodys are answerable to no one for the public money they spend
    There is no data as to how many of their trainees are practicing general practitioners five, ten, and 20 years down the line, how many fail their exams, and how many times, and indeed how many have nervous breakdowns, in short there is no interest whatsoever in any review whatsoever of their performance.
    Until general practitioners are trained to make general practice something that is enjoyable and worthwhile, no one will want to do it

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  • They just need to let more in! My son, bright caring hard working - predicted great grades - has been applying for medicine against my and my wife (also a GP) - advice. Hasnt had a single offer. hes twice as mature as i was at his age - also he knows what medicine is - i didnt i didnt come from a medical background. apparently Keele his preferred med school had 3500 applications for 130 places. they interviewed 500 - (inc my son). Ok its not a quick win would take 7-8 years but it strikes me if they doubled the intake now we could sort the recruitment crisis and it would hardly be a lowering of standards. esp as there are figures that retention rates are really low.

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  • This is a classic example of avoiding the blindingly obvious. GP recruitment and retention is poor because of the appalling demands made upon primary care by comparison with the increasingly reduced remuneration we receive, and the constant hectoring and vilification of us. Sort out the conditions of work, and the rest will follow automatically. Not rocket science.

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  • My daughter is an Oxford medical student. She is being taught by demoralised Consultants, GPs who hate the job and hospital registrars who are increasingly looking at alternatives to medicine if the new contract is genuinely imposed. I suspect that more and more medical students will not complete their courses and more and more will not go into coalface medicine. Well done NHSE.

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  • MORE CRAP!

    IT IS NOT THE FAULT OF MEDICAL SCHOOLS!!

    IT IS SIMPLE MARKET FORCES, WHICH THE TORIES WILL NOT ACCEPT
    (UNLESS TO DO WITH BANKERS WHO MUST BE PAID MEGABUCKS-DUE TO "MARKET FORCES")

    NOBODY WANTS TO BE A GP BECAUSE AS A CAREER IT IS "A FORM OF SELF-HARM" IN EFFECT.

    UNTIL GOV/DOH STOP TREATING GPs LIKE CRAP THE PROBLEM WILL CONTINUE....PUBLISH THAT IN THE DAILY MAIL.........

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  • 10:21 GP Partner
    As an ex-Partner in my 30s - tell your son again to be very thankful he was not successful, and choose a job which will pay the mortgage and not ruin his life. I would not encourage anyone to train for this job - yes the salary is ok, but it is not worth a life of slavery. 13-15 hour days, 60+ patients a day, ready to collapse all the time ... I would not wish it on anyone!

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  • Anon 10:29am. Please don't shout. It makes me (and probably others) avoid reading ANY of your mail.

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  • I like shouty people - it adds texture.

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  • The DOH reduces funding to GP land by almost 40% over the last 10 years as a form of penance. It is the fault of medical schools who have a' responsibility' to train GPs. Why should they. It s still a free country, last I looked and medical students can go where ever they wish.
    Keep on cutting the % of NHS spend on GPs, keep on increasing their workloads, so we now see 90% of contacts on 7.20 % of NHS budget and that is a clear message of how valued we are. Medical students have 4A*. They know a pig in a poke.
    Besides all this, the argument fails because GPs are leaving early.
    No point getting them to GP land if the job is so awful they all want to leave.
    Read Peverley, Copperfield, Nabi, anybody.
    They collectively say one thing, don't be a GP.

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  • so their going to pay the rubbish med schools more? More bullshit

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  • @10:29

    I like your "shouty" message and agree wholeheartedly with you.

    Discussing what percentage of medical students train in primary or secondary care seems a little futile against the current conditions where many of us are demoralised and are look at ways to get out of this awful broken NHS system.

    There is very limited money available for public sector spending according to the treasury. It is NOT going to ever match what is needed for a high quality NHS service in terms of keeping both the workers and the public happy.

    As Johann Malawanna states: The U.K. has 2 choices. 1. Cut services in healthcare to fit budget. 2. Provide the budget to fit healthcare we want. Honest debate is needed

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  • I don't think it's just a problem with recruiting trainees or retaining senior GPs, it's also that many Gp Registrars who complete their GP training won't take up a full time GP job if at all these days. I know two colleagues who plan to quit medicine after they complete their GP training and another colleague who plans to enter another training program when he completes his GP training.

    With General Practice being the complete load of rubbish it is at the moment with phenominal responisbility, high risk, high stress, long hours for very very very little return I have almost zero interest in joining the GP workforce.

    Unfortunately I see no solution to this apart from the government putting a lot more money into primary care to provide extra services and staff to take some of the load of GPs, but this is never going to happen.

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  • who comes up with this nonsense. blame the government for all the probelms, not the medical schools. Doctors are not idiots, they know what is going. simple things first
    1) stop appraisal and revalidation
    2) ban cqc
    3) stop press pr against doctors
    4) get rid of hunt
    5) pay doctors per patient seen (like the rest of world)
    6) take government interference out of General practice.
    7) have a limit to what is safe - 25-30 patients maximum

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  • So nobody thinks that actually improving General Practice as a career is a good idea?

    Really?

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  • You can not push graduates to General practice through the back door. A graduate can only choose General Practice if he or she sees flexible working practices, no weekends, good pay, low workloads and good quality consultations - no trivia etc etc.

    Mr Hunt is making sure this is not possible, not in "his NHS".

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  • Things are terrible now, but are about to become much worse.. Welcome to the new salaried low income GP production line working for a PLC. No continuity of care. No small team working. The job of the new 200,000 patient GP mega practice broken down to different departments..

    1/ Telephone consultations from angry patients wanting to be seen and having to limit their demands
    2/ Seeing huge numbers of angry patients demanding everything and having to deal with patients who do not fit the protocol e.g. for a brain CT for their headache that started that morning with no red flags...
    3/ On going round of QoF..
    4/ On going reading and acting on letters from hospital
    5/ Complaints dept
    6/ HR, commissioning, education updating
    7/ Home visits
    8/ Reading and acting on investigations.

    Imagine doing this for 200,000 patients as one minor cog for the rest of your life. Where is the enjoyment in that?

    Doctors used to pick general practice because they had a degree of autonomy and could work with a team that they picked, got to know and trusted. Patients respected them. Workload was manageable. There was time to socialise among the team. Pensions were good. It felt like an extended family.

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  • more lambs to the slaughter !

    there is so much choice for ambitious young scientists - why destroy your life ?

    look at Elon Musk, Steve Jobs, Criag Venter etc

    it's an exciting time to be in science but medicine ? it's no fun being a political football, a dump sink for all the problems that society doesn't want to deal with, and the convenient scape-goat for politicians and the media. Until the system collapses and we have something sensible in place - I wouldn't touch it with a barge pole.

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  • I heard an interview by one of the Profs at Harvard Medical School that he was proud that not a single student went into family medicine that year.General Practice is no career for an intelligent person and more should be done to deter them.

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  • My son is finishing his final year at Cambridge and is very unlikely to become a GP.
    But it is probably because his mum and dad are both NHS GPs and tell him not to!
    And he isnt stupid.

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  • Vinci Ho

    Again
    Somebody proposed a monetary measure to force a 'desirable' outcome . Fudamentally , these theorists are running out of ideas. Addressing the attitude amongst medical schools on general practice is one thing and coercing/tempting students to choose something is entirely another matter. Trying to use money to change the social norms in these medical schools is so naive and far-fetching! And stop referring to so called references. A political problem/crisis needs a political solution.
    What makes you think this bunch of politicians is going to listen to you anyway?

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  • There exists a widely held view, valid or not, the general practise is for the thickies who made it into medical school and survived to graduate. Why should any right-thinking medical school believe that directing more of its intake down this sorry path would be seen as a positive reflection upon its own capabilities and standards?

    We live in muddled times where its felt that GPs need to be taught resilience to continue under adverse conditions without addressing the underlying causes. A bit like instructing the POWs who built the Burma railway to employ proper lifting techniques to keep their backs healthy.

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  • right after 2004 contract there was a surge of interest in General Practice - why? it was simply a decent contract with investment. it's not rocket science. after being betrayed by the state the clock has been turned back to pre-2004 but this time there is no trust and no money. In short there is no way anything is going to improve. It can only get worse. The example of Chorley Hospital will be the new norm with departments shutting due to lack of staff. You can blame who you like - medical schools, hospitals, managers - it won't matter. Who will willingly want to be a GP dealing with such demand, litigation, stress, rising risk and falling rewards. Getting lunch is a perk of the job now - that's how bad it is. Would you want your family member to be a GP? You'd be better off on the dole.

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  • as the Bard said, 'you can't polish a turd Horatio'.
    Between them the DoH, RCGP, GMC and CQC have made GP a poisonous environment. One thing would make it bearable and that is a return to the financial recompense that we enjoyed 20 years ago.
    PS I've waited patiently for 20 years as my senior colleagues collected their seniority pay and pensions, and now f*** me if it hasn't been robbed off me when it came to my turn

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  • If I was a Med school I would take pride in producing no GP's.

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